Quality of Life in Patients With Asymptomatic Primary Hyperparathyroidism After Parathyroidectomy: A 3-Year Longitudinal Study

Tzikos, Georgios; Chorti, Angeliki; Evangelos, Sykaras; Boura, Evangelia; Manani, Christina; Adamidou, Fotini; Tziatzios, Ioannis; Zisi, Anna; Economou, Fotios; Toulis, Konstantinos; Pliakos, Ioannis; Michalopoulos, Antonios; Papavramidisos, Theodosios

doi:10.1016/j.eprac.2021.01.003

Cited by 11 publications

(14 citation statements)

References 33 publications

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“…This area continues to need additional studies, aided perhaps by utilizing a disease‐specific quality‐of‐life tool for PHPT. ( 48,49 ) Cardiovascular/metabolic : Previous small studies reported an increased risk of hypertension, ( 50 ) left ventricular hypertrophy, and impaired diastolic filling in patients with PHPT, ( 51 ) although the pathophysiologic mechanisms underlying these associations have not been identified. Patients with both normocalcemic and classic PHPT have been shown to exhibit similar rates of cardiovascular risk factors and comparable indices of arterial stiffness.…”

Section: Evaluation For Non‐classical Manifestationsmentioning

confidence: 99%

Management of Primary Hyperparathyroidism

Bilezikian

Silverberg

Bandeira

et al. 2020

Journal of Bone and Mineral Research

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Since the last international guidelines were published in 2014 on the evaluation and management of primary hyperparathyroidism (PHPT), new information has become available with regard to evaluation, diagnosis, epidemiology, genetics, classical and nonclassical manifestations, surgical and nonsurgical approaches, and natural history. To provide the most current summary of these developments, an international group, consisting of over 50 experts in these various aspects of PHPT, was convened. This paper provides the results of the task force that was assigned to review the information on the management of PHPT. For this task force on the management of PHPT, two questions were the subject of systematic reviews using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The full report addressing surgical and nonsurgical management of PHPT, utilizing the GRADE methodology, is published separately in this series. In this report, we summarize the results of that methodological review and expand them to encompass a much larger body of new knowledge that did not specifically fit the criteria of the GRADE methodology. Together, both the systematic and narrative reviews of the literature, summarized in this paper, give the most complete information available to date. A panel of experts then considered the last set of international guidelines in light of the newer data and assessed the need for their revision. This report provides the evidentiary background to the guidelines report. In that report, evidence from all task forces is synthesized into a summary statement and revised guidelines for the evaluation and management of PHPT. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Section: Evaluation For Non‐classical Manifestationsmentioning

confidence: 99%

Management of Primary Hyperparathyroidism

Bilezikian

Silverberg

Bandeira

et al. 2020

Journal of Bone and Mineral Research

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“…Another study providing a long-term analysis was published in 2019 by Tzikos et al [25] and confirmed the QoL benefits of PTx over non-PTx in asymptomatic PHP. The participants who were either treated with PTx (N = 18) or conservative (N = 20) had a PAS-Q total score before surgery decrease 3 months post-PTx (p = 0.003), meaning a QoL improvement, respectively, 3-year post-PTx (p = 0.001) when compared to the second group where PAS-Q score increased versus baseline (p = 0.019) and it became higher than in the PTx group after 3 years (p = 0.021) [25].…”

Section: Conservative Approach In Primary Hyperparathyroidism and Qolmentioning

confidence: 66%

“…As previously mentioned, PTH-dependent hypercalcemia displays a certain influence on QoL, but not all studies agree on this matter [17,24,25]. For example, Christensen et al [17] did not identify a significant relationship between QoL and calcium levels dynamics, as oppsed to other researchers.…”

Section: Primary Hyperparathyroidism-related Serum Calcium and Qol In...mentioning

confidence: 95%

“…PTx contribution to QoL improvement versus a conservative approach typically was taken into consideration for those patients who were not immediate candidates for surgery, according to standard guidelines (by not having the criteria or by displaying severe co-morbidities that required a delay of the surgery) [6]. The impact of conservative management in PHP was assessed based on longitudinal data or with regard to the impact of PTx-associated analysis or by comparing the subjects with normal (non-PHP) population [13,15,[20][21][22][23][24][25].…”

Section: Conservative Approach In Primary Hyperparathyroidism and Qolmentioning

confidence: 99%

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Neuroendocrine Parathyroid Tumors: Quality of Life in Patients with Primary Hyperparathyroidism

et al. 2023

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Tumors of the parathyroid glands, when associated with PTH (parathyroid hormone) excess, display a large area of complications; in addition to the classical clinical picture of primary hyperparathyroidism (PHP), a complex panel of other symptoms/signs can be identified, including memory and cognitive impairment, chronic asthenia/fatigue, reduced muscle functionality, depressive mood, non-specific bone pain, and loss of sleep quality. The perception of quality of life (QoL) can be supplementarily enhanced by their progressive onset, which makes many patients not be fully aware of them. Their improvement was reported very early after parathyroidectomy (PTx), yet the level of statistical evidence does not qualify these non-classical elements as standalone indications for PTx. Our objective is introducing an up-to-date on QoL scores with regards to the patients diagnosed with PHP, particularly taking into consideration PHP management from baseline to post-operatory outcome, including in cases with multiple endocrine neoplasia. This is a narrative review of literature. We revised full-length papers published in English through PubMed research conducted between January 2018 and May 2023 by using the key words “quality of life” and “primary hyperparathyroidism”. We particularly looked at data on self-reported QoL (through questionnaires). We excluded from the search the studies focused on non-PTH related hypercalcemia, secondary, and/or renal/tertiary hyperparathyroidism, and vitamin D supplementation. Overall, we identified 76 papers and selected for the final analysis 16 original studies on QoL and PHP (a total of 1327 subjects diagnosed with syndromic and non-syndromic PHP). The studies with the largest number of individuals were of 92, 104, 110, 134, 159, as well as 191. A few cohorts (n = 5) were of small size (between 20 and 40 patients in each of them). Concerning the study design, except for 2 papers, all the mentioned studies provided longitudinal information, particularly the timeframe from baseline (before PTx) and after surgery. The post-operatory follow-up was of 3–6 months, but mostly between 1 and 3 years (maximum a decade of surveillance). The age of the patients varies between medians of 56, 62, 64, and 68 years. Most frequent questionnaires were SF-36, PHPQoL, and PAS. Despite not being unanimously similar, an overall reduced score of QoL in patients with PHP versus controls was registered, as well as general improvement following PTx. Variations of QoL results might have a multifactorial background from different comorbidities, studied populations, technical aspects of collecting the data, etc. QoL scores in PHP represents a complex heterogeneous picture, from their correlation with clinical features and lab assays (e.g., the level of serum calcium), the associated comorbidities (such as multiple endocrine neoplasia syndromes), up to the assessment of the QoL improvement after parathyroidectomy (PTx). While current studies do not unanimously agree on each QoL domain, the assessment of QoL might represent a supplementary argument to consider when deciding for PTx, especially in asymptomatic cases and in patients who do not fit into well-known categories of surgery candidates, according to current guidelines, thus assessing QoL in PHP is part of a current research gap. QoL evaluation in PHP remains an open issue, towards which awareness should be cultivated by both endocrinologists and surgeons. The introduction of a routine evaluation of the QoL scores in patients, as well as the selection of the most appropriate questionnaire(s), represents an open chapter thus awareness in mandatory.

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“…The typical electrolyte disorder in PHPT is hypercalcemia, whereas a normocalcemic form of PHPT was recognized almost 15 years ago. The classical clinical presentation is characterized by overt involvement of kidney and bone, while the non-classical disease manifestations include cardiovascular, gastrointestinal, psychiatric, neurocognitive, and quality of life issues [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Parathyroidectomy on Left Ventricular Mass Index in Patients With Primary Hyperparathyroidism

Tzikos¹,

Doundoulakis²,

Doutsini³

et al. 2023

Cureus

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Primary hyperthyroidism (PHPT) is known to affect left ventricular structure and function and may contribute to increased cardiovascular morbidity and mortality. Whether parathyroidectomy (PTX) reverses left ventricular hypertrophy/remodeling among PHPT patients remains controversial. MethodIn this prospective, single-center study, we enrolled patients with the diagnosis of PHPT who were scheduled for PTX. Patients underwent a complete biochemical workup and an echocardiographic examination at baseline and a six-month follow-up. The primary objective was to compare the left ventricular mass index (LVMI) at baseline and six-month follow-up. ResultEighteen patients (15 female, three male, mean age 58.7 years) were enrolled. PTH and serum calcium returned to normal immediately post-PTX and remained normal at six months. LVMI at baseline was within normal limits and reduced further at the six-month follow-up. The left ventricular ejection fraction was in the normal range before the PTX and remained unchanged during follow-up. ConclusionCurative PTX reduced LVMI further within the normal range at six months in patients with asymptomatic hyperparathyroidism, providing evidence for benefit in an important non-traditional disease manifestation.

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Quality of Life in Patients With Asymptomatic Primary Hyperparathyroidism After Parathyroidectomy: A 3-Year Longitudinal Study

Cited by 11 publications

References 33 publications

Management of Primary Hyperparathyroidism

Management of Primary Hyperparathyroidism

Neuroendocrine Parathyroid Tumors: Quality of Life in Patients with Primary Hyperparathyroidism

Effect of Parathyroidectomy on Left Ventricular Mass Index in Patients With Primary Hyperparathyroidism

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